Provider Demographics
NPI:1740417062
Name:ACME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:ACME HEALTHCARE, INC.
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OOMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-400-4524
Mailing Address - Street 1:350 OAKS TRL STE 202
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-4086
Mailing Address - Country:US
Mailing Address - Phone:972-240-4099
Mailing Address - Fax:214-602-3949
Practice Address - Street 1:350 OAKS TRL STE 202
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-4086
Practice Address - Country:US
Practice Address - Phone:972-240-4099
Practice Address - Fax:214-602-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016701OtherTEXAS HEALTH AND HUMAN SERVICES COMMISSION